Implants for HIV prevention in young women: Provider perceptions and lessons learned from contraceptive implant provision

Preventing new HIV infections, especially amongst young women, is key to ending the HIV epidemic especially in sub-Saharan Africa. Potent antiretroviral (ARV) drugs used as pre-exposure prophylaxis (PrEP) are currently being formulated as long-acting implantable devices, or nanosuspension injectables that release drug at a sustained rate providing protection from acquiring HIV. PrEP as implants (PrEP Implants) offers an innovative and novel approach, expanding the HIV prevention toolbox. Feedback from providers and future users in the early clinical product development stages may identify modifiable characteristics which can improve acceptability and uptake of new technologies. Healthcare workers (HCWs) perspectives and lessons learned during the rollout of contraceptive implants will allow us to understand what factors may impact the roll-out of PrEP implants. We conducted eighteen interviews with HCWs (9 Nurses and 9 Community Healthcare Workers) in rural KwaZulu-Natal, South Africa. HCWs listed the long-acting nature of the contraceptive implant as a key benefit, helping to overcome healthcare system barriers like heavy workloads and understaffing. However, challenges like side effects, migration of the implant, stakeholder buy-in and inconsistent training on insertion and removal hampered the roll-out of the contraceptive implant. For PrEP implants, HCWs preferred long-acting products that were palpable and biodegradable. Our findings highlighted that the characteristics of PrEP implants that are perceived to be beneficial by HCWs may not align with that of potential users, potentially impacting the acceptability and uptake of PrEP implants. Further our data highlight the need for sustained and multi-pronged approaches to training HCWs and introducing new health technologies into communities. Finding a balance between the needs of HCWs that accommodate their heavy workloads, limited resources at points of delivery of care and the needs and preferences of potential users need to be carefully considered in the development of PrEP implants.

Remote Monitoring of Patient- and Family-Generated Health Data in Pediatrics

Remote patient monitoring (RPM) is a form of telemedicine that involves the collection and transmission of health data from a patient to their health care team by using digital health technologies. RPM can be leveraged to aggregate and visualize longitudinal patient-generated health data for proactive clinical management and engagement of the patient and family in a child’s health care. Collection of remote data has been considered standard of care for years in some chronic pediatric conditions. However, software limitations, gaps in access to the Internet and technology devices, digital literacy, insufficient reimbursement, and other challenges have prevented expansion of RPM in pediatric medicine on a wide scale. Recent technological advances in remote devices and software, coupled with a shift toward virtual models of care, have created a need to better understand how RPM can be leveraged in pediatrics to improve the health of more children, especially for children with special health care needs who are reliant on high-quality chronic disease management. In this article, we define RPM for the general pediatric health care provider audience, provide case examples of existing RPM models, discuss advantages of and limitations to RPM (including how data are collected, evaluated, and managed), and provide a list of current RPM resources for clinical practitioners. Finally, we propose considerations for expansion of this health care delivery approach for children, including clinical infrastructure, equitable access to digital health care, and necessary reimbursement. The overarching goal is to advance health for children by adapting RPM technologies as appropriate and beneficial for patients, families, and providers alike.

Proposing methods to explore the evolution of the term ‘mHealth’ on the Danish Web archive

This article uses Internet archives to explore the emergence and spread of the term ‘mHealth’ (mobile health technologies) in the Danish Web domain from 2006 to 2018, focusing on the actors that contributed to its evolution. We propose three methods for investigating the Web pages and Web sites that employed the term ‘mHealth’. Our findings highlight temporal developments in the use of ‘mHealth’, with diverse actors using it, though none clearly dominated. The article attends to challenges in working with Web archive data, and presents methods that can be used by others wishing to engage empirically with Internet archives, which remain vast, but largely under-exploited resources.

Exploratory attitude survey of homeless persons regarding telecare services in shelters providing mid- and long-term accommodation: The importance of trust

Background With the expansion of digital health, it is imperative to consider intervention techniques in order not to be the cause of even more social health inequalities in underserved populations struggling with chronic diseases. Telemedicine solutions for homeless persons might compensate for shortcomings in access to valuable health services in different settings. The main aim of our research was to examine the attitudes and openness of homeless persons regarding telecare on a Hungarian sample. Methods Quantitative survey among homeless people (n = 98) was completed in 4 shelters providing mid- and long-term accommodation in Budapest, Hungary. Attitudes regarding healthcare service accessibility and telecare were measured by a self-developed questionnaire of the research team. Telecare attitude comparison was made with data of a Hungarian weighted reference group of non-homeless persons recruited from 2 primary care units (n = 110). Results A significant fraction of homeless people with mid- or long-term residency in homeless shelters did not oppose the use of telecare via live online video consultation and there was no difference compared to the national reference group (averages of 3.09 vs. 3.15, respectively). Results of the homeless group indicate that those more satisfied with healthcare services, in general, manifest more openness to telecare. It is clearly demonstrated by the multivariate analysis that those participants in the homeless group who had problems getting health care in the last year definitely preferred in-person doctor-patient consultations. Conclusion Digital health technologies offer a potentially important new pathway for the prevention and treatment of chronic conditions among homeless persons. Based on the attitudes towards telecare, initiating an on-site telecare program for mid- and long-term residents of homeless shelters might enable better care continuity. Our results draw attention to the key factors including building trust in the implementation of such programs among underserved and other vulnerable patient groups.

Activity of a psychologist in a Medical Specialties Unit: Ambulatory Center for the Prevention and Attention of AIDS and other sexually transmitted infections.

Introduction: The attention provided at Medical Specialties Unit (UNEME), Ambulatory Center for the Prevention and Attention of AIDS and other sexually transmitted diseases (CAPASITS), the psychologist develops activities that strengthen the patients’ treatment, as a part of a multidisciplinary work. In this way, it becomes essential knowing the importance of the psychologist activities and how they get involved in the Public Health problems. Objective: To analyze the professional competencies that psychologists must possess and how they apply them in their activity at the UNEME CAPASITS Material and Methods: A descriptive bibliographic review was carried out. For the inclusion criteria, it was considered that they will report on: the development of professional skills of health psychologists, the activity of psychologists in public health institutions, development of professional skills of the psychologist and the objectives of health psychology. To search for information, the following keywords were used: health psychology, activity and professional skills. The bibliographic search was performed in the databases: EBSCO, ScienceDirect, Dialnet, PubMed, REdalyc, ResearchGate and pages from official sites: WHO and the National Center for the Prevention and Control of HIV and AIDS. Results: From the analyzed information it was found that the professional competencies that the psychologist must possess in the field of health are focused on the management of preventive strategies, use of health technologies, creation of plans and programs to promote a healthy lifestyle, evaluation and treatment as well as collaborative work. Conclusions: The UNEMES CAPSITS require that psychologists possess competencies such as: communication, use of information and communication technologies (ICT), research, evaluation for treatment, monitoring and creation of clinical records, in addition to: research for health and the dissemination of the results, especially in the treatments.

How innovation can be defined, evaluated and rewarded in health technology assessment

Background What constitutes innovation in health technologies can be defined and measured in a number of ways and it has been widely researched and published about. However, while many countries mention it as a criterion for pricing or reimbursement of health technologies, countries differ widely in how they define and operationalise it. Methods We performed a literature review, using a snowballing search. In this paper, we explore how innovation has been defined in the literature in relation to health technology assessment. We also describe how a selection of countries (England, France, Italy, Spain and Japan) take account of innovation in their health technology assessment frameworks and explore the key methodologies that can capture it as a dimension of value in a new health technology. We propose a way of coming to, and incorporating into health technology assessment systems, a definition of innovation for health technologies that is independent of other dimensions of value that they already account for in their systems, such as clinical benefit. We use Spain as an illustrative example of how innovation might be operationalised as a criterion for decision making in health technology assessment. Results The countries analysed here can be divided into 2 groups with respect to how they define innovation. France, Japan and Italy use features such as severity, unmet need and therapeutic added value as indicators of the degree of innovation of a health technology, while England, Spain consider the degree of innovation as a separate and additional criterion from others. In the case of Spain, a notion of innovation might be constructed around concepts of `step-change’, `convenience’, `strength of evidence base’ and `impact on future research & development’. Conclusions If innovation is to be used as operational criteria for adoption, pricing and reimbursement of health technologies, the concept must be clearly defined, and it ought to be independent from other value dimensions already captured in their health technology assessment systems.

Ethical and Regulatory Challenges of Emerging Health Technologies

The advances in biotechnology and computer and data sciences opened the way for innovative approaches to human healthcare. Meanwhile, they created many ethical and regulatory dilemmas such as pervasive global inequalities and security and risk to data privacy. The assessment of health technology is a systematic multidisciplinary process that aims to examine the benefits and risks associated with its use including medical, social, economic, and ethical impacts. It is used to inform policy and optimize decision-making. The advance of technology is creating significant challenges to healthcare regulators who strive to balance patient safety to fostering innovation. The FDA and EMA are modernizing their regulatory approaches to foster innovation in digital technology and improve safety and applicability to patients. On the other hand, data analytic technologies have been introduced into regulatory decision processes.

The Science of Individuality and Tailored M-Health Communication

The era of the science of individuality promises to fully recognize the uniqueness of the individual who needs to be seen and treated with utter respect for his or her individuality. It will not be long until digitizing a person unlocks the cause for what is wrong, creating valuable knowledge that can save a life or markedly improve the quality of life. On the other hand, emerging m-health technologies provide fundamentally different ways of looking at tailored communication technology. As a result, tailored communications research is poised at a crossroads. It needs to both build on and break away from existing frameworks into new territory, realizing the necessary commitment to theory-driven research at basic, methodological, clinical, and applied levels. The chapter envisions tailored m-health communication in the context of the science of individuality, emphasizing the variability, stability, and centrality of the individual.

Back to the Basics

Health literacy is a critical foundation that needs to be considered prior to the development and deployment of consumer e-health technologies. The authors indicate the problems associated with the lack of effective health literacy strategies in current consumer e-health interventions and then present a patient-centered, disease-specific, task-relevant, and contextualized health literacy approach. The goal of such an approach is to help patients better understand their illnesses make sense of their health data, make informed decisions, and more effectively manage their health conditions. The authors make five recommendations concerning health literacy in order to make e-health interventions effective. They also describe next-generation health literacy interventions that take advantage of emerging technologies such as speech recognition, natural language processing, artificial intelligence, automatic translation, and augmented reality. Finally, the authors point out a research and development direction towards an intelligent, integrated, and connected consumer e-health solution.